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An illustration showing a variety of wounds from the Feldbuch der Wundarznei (Field manual for the treatment of wounds) by Hans von Gersdorff, (1517); illustration by Hans Wechtlin.
Battlefield medicine, also called field surgery and later combat casualty care, is the treatment of wounded combatants and non-combatants in or near an area of combat. Civilian medicine has been greatly advanced by procedures that were first developed to treat the wounds inflicted during combat. With the advent of advanced procedures and medical technology, even polytrauma can be survivable in modern wars. Battlefield medicine is a category of military medicine.
Chronology of medical advances on the battlefield
A wounded knight is carried on a medieval stretcher.
During Alexander the Great's military campaigns in the fourth century BC, tourniquets were used to stanch the bleeding of wounded soldiers.Romans used them to control bleeding, especially during amputations. These tourniquets were narrow straps made of bronze, using only leather for comfort.
An early stretcher, likely made of wicker over a frame, appears in a manuscript from c.1380. Simple stretchers were common with militaries right through the middle of the 20th century.
Ambroise Paré, on the battlefield using a ligature for the artery of an amputated leg of a soldier.
French military surgeon Ambroise Paré (1510-90) pioneered modern battlefield wound treatment. His two main contributions to battlefield medicine are the use of dressing to treat wounds and the use of ligature to stop bleeding during amputation.
The practice of triage pioneered by Dominique Jean Larrey during the Napoleonic Wars (1803-1815). He also pioneered the use of ambulances in the midst of combat ('ambulances volantes', or flying ambulances). Prior to this, military ambulances had waited for combat to cease before collecting the wounded by which time many casualties would have succumbed to their injuries.
In the late 19th century, the influence of notable medical practitioners like Friedrich von Esmarch and members of the Venerable Order of Saint John pushing for every adult man and woman to be taught the basics of first aid eventually led to institutionalised first-aid courses amongst the military and standard first-aid kits for every soldier.
The use of helicopters as ambulances, or MEDEVACs was first practiced in Burma in 1944. The first MEDEVAC under fire was done in Manila in 1945 where over 70 troops were extracted in five helicopters, one and two at a time.
The use of Remote physiological monitoring devices on soldiers to show vital signs and biomechanical data to the medic and MEDEVAC crew before and during trauma. This allows medicine and treatment to be administered as soon as possible in the field and during extraction.
Current battlefield medicine used by the U.S military
Over the past decade combat medicine has improved drastically. Everything has been given a complete overhaul from the training to the gear. In 2011, all enlisted military medical training for the U.S. Navy, Air Force, and Army were located under one command, the Medical Education and Training Campus (METC). After attending a basic medical course there (which is similar to a civilian EMT course), the students go on to advanced training in Tactical Combat Casualty Care.
Tactical Combat Casualty Care
Today, TCCC is becoming the standard of care for the tactical management of combat casualties within the Department of Defense and is the sole standard of care endorsed by both the American College of Surgeons and the National Association of EMT's for casualty management in tactical environments.
TCCC is built around three definitive phases of casualty care:
Care Under Fire: Care rendered at the scene of the injury while both the medic and the casualty are under hostile fire. Available medical equipment is limited to that carried by each operator and the medic. This stage focuses on a quick assessment, and placing a tourniquet on any major bleed.
Tactical Field Care: Rendered once the casualty is no longer under hostile fire. Medical equipment is still limited to that carried into the field by mission personnel. Time prior to evacuation may range from a few minutes to many hours. Care here may include advanced airway treatment, IV therapy, etc. The treatment rendered varies depending on the skill level of the provider as well as the supplies available. This is when a corpsman/medic will make a triage and evacuation decision.
Tactical Evacuation Care (TACEVAC): Rendered while the casualty is evacuated to a higher echelon of care. Any additional personnel and medical equipment pre-staged in these assets will be available during this phase.
Since "90% of combat deaths occur on the battlefield before the casualty ever reaches a medical treatment facility" (Col. Ron Bellamy) TCCC focuses training on major hemorrhaging and airway complications such as a tension-pneumothorax. This has driven the casualty fatality rate down to less than 9%.
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